Abstract
BackgroundObstructive sleep apnea syndrome (OSAS) may be associated with an increase in hypothalamic-pituitary-adrenocortical axis activity (HPA AA). We reviewed research comparing morning salivary and blood (serum and plasma) cortisol concentrations of individuals with OSAS to those of healthy controls.MethodsWe made a systematic search without any restrictions of the PubMed/Medline, Scopus, Cochrane Library, and Web of Science databases for relevant articles published up to August 25, 2019.ResultsSixteen studies were analyzed in this meta-analysis; five studies compared morning salivary concentrations, five compared serum concentrations, four compared plasma cortisol concentrations, and two compared both salivary and plasma concentrations. In pediatric samples, compared to healthy controls, those with OSAS had significantly lower saliva morning cortisol concentrations (MD = -0.13 µg/dl; 95% CI: 0.21, -0.04; P = 0.003). In contrast, no significant differences were observed for serum cortisol concentrations, plasma cortisol concentrations, or salivary morning cortisol concentrations between adults with and without OSAS (p = 0.61, p = 0.17, p = 0.17).ConclusionCortisol concentrations did not differ between adults with OSAS and healthy controls. In contrast, morning salivary cortisol concentrations were lower in children with OSAS, compared to healthy controls. Given that a reduced HPA AA is observed among individuals with chronic stress, it is conceivable that children with OSAS are experiencing chronic psychophysiological stress.
Highlights
Obstructive sleep apnea syndrome (OSAS) is one of the most common breathing disorders of sleep, with significant consequences for quality of life [1]
Inclusion criteria: I) studies with case-control design without age, sex, or body mass index (BMI) restrictions, II) OSAS was defined as Apnea–Hypopnea Index (AHI) > 5 events/h in adults, and AHI > 1 events/h in children, III) OSAS was diagnosed on the basis of polysomnography, IV) controls had mild OSAS and no other systematic diseases, V) OSAS patients had no other systematic diseases, VI) studies reporting pretreatment morning salivary, serum, and/or plasma levels of cortisol, and (II) studies having sufficient data to calculate the mean difference (MD) and 95% confidence interval (CI)
One was a book chapter, one reported urinary free cortisol, one focused on other endocrine outcomes, one reported overnight level of cortisol, one had data overlapping with another study, and one study reported serum level of cortisol in children
Summary
Obstructive sleep apnea syndrome (OSAS) is one of the most common breathing disorders of sleep, with significant consequences for quality of life [1]. The occurrence of OSAS is critical because both in children and adults it is associated with an increased risk of systemic comorbidities such as cardiovascular diseases, hypertension, metabolic syndrome, and cognitive impairments [2, 3]. The most important epidemiological risk factors for OSAS are obesity and male gender [9, 10]. OSAS plays an important role in the emergence and maintenance of hypertension, while snoring is a risk factor for hypertension independent of body mass index (BMI), AHI, or older age [11]. Obstructive sleep apnea syndrome (OSAS) may be associated with an increase in hypothalamic-pituitary-adrenocortical axis activity (HPA AA). We reviewed research comparing morning salivary and blood (serum and plasma) cortisol concentrations of individuals with OSAS to those of healthy controls
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